Sec. 8. (a) The office of family and social services shall study Medicaid reimbursement rates and the methodology for case management services for recipients of the Medicaid family support waiver and the Medicaid community integration and habilitation waiver.

(b) The office of family and social services may contract with a vendor to conduct the reimbursement rate and time and effort study in subsection (a).

(c) The results of the study in subsection (a) must include all activities of case management services specified in the Medicaid family support waiver and the Medicaid community integration and habilitation waiver, including the following:

(1) Case manager activities related to the transition of a participant from an institutional setting.

(2) Ensuring the ongoing facilitation of the person centered planning process.

(3) Developing, updating, and reviewing the person centered individualized support plan and related documents.

(4) Facilitating the integration of risk identification, planning, and mitigation in the person centered individualized support plan process.

(5) Convening team meetings.

(6) Monitoring of service delivery and utilization.

(7) Completing and processing the annual level of care determination.

(8) Completing case notes for all actions on behalf of the consumer.

(9) Convening and conducting all required and as needed face-to-face contacts.

(10) Completing and processing the monitoring checklist.

(11) Developing, submitting, and confirming initial, annual, reentry, and updated cost comparison budgets.

(12) Disseminating information, including all notices of action and forms to the participant, guardian, and the individualized support team.

(13) Developing and submitting budget modification requests, budget review questionnaires, and data entry worksheets, as needed.

(14) Developing and submitting the request for authorization, as outlined in the division of disability and rehabilitative services waiver manual, verifying the service is provided and the equipment is received.

(15) Completing, submitting, and following up on nonsentinel incident reports.

(16) Completing all required processes and procedures as outlined in the bureau of quality improvement services sentinel event protocol.

(17) Completing all required processes and procedures as outlined in the bureau of quality improvement services mortality review protocol, as requested.

(18) Monitoring participants' health, safety, and welfare.

(19) Monitoring participants' satisfaction and service outcomes.

(20) Monitoring claims reimbursed through the approved Medicaid management information system and pertaining to waiver funded services.

(21) Maintaining files according to state standards.

(22) Cultivating and strengthening informal and natural supports for each participant.

(23) Identifying resources and negotiating the best solutions to meet identified needs.

(24) Completing the onboarding process for referrals.

(25) Completing the intake requirements and process for all referrals new to a waiver.

(26) Costs associated with initial and ongoing training for case managers.

(27) Costs associated with the on call system.

(28) Costs associated with the requirement to employ or contract with a registered nurse.

(29) Costs associated with the requirement to be accredited.

(30) Costs associated with maintaining the required quality assurance systems.

(31) Costs associated with providing supervision and support of case managers.

(32) Specific case manager requirements related to persons assessed to be at the Algo 6 level assessment level.

(d) The results of the study must include the following:

(1) An analysis and comparison of service rates and rate structures for similar services in comparable states and the number of hours of service per person per month provided for each rate.

(2) An analysis and comparison of competitive market rates and rate structures for similar services in Indiana and the number of hours of service per person per month provided for each market rate.

(3) Recommendations for Medicaid rates for case management services for recipients of the Medicaid family support waiver and the Medicaid community integration and habilitation waiver.

(4) The methodology for arriving at the recommended rates and number of hours or units for each rate.

(5) The amount of state dollars needed to adequately fund the service for all potentially and currently eligible recipients under the recommended Medicaid rates.

(6) The number of all potential and current persons eligible to receive case management services.

(e) Any new rates as a result of a study under this section:

(1) may not:

(A) take effect until at least January 1, 2019; and

(B) be applied retroactively to any claim or approved service before the effective date of the new rate; and

(2) must be approved by the federal Department of Health and Human Services through a Medicaid waiver amendment applied for by the office of the secretary.

(f) The office of family and social services shall present the results of the study to the budget committee before January 1, 2019.

(g) This section expires July 1, 2019.

As added by P.L.209-2018, SEC.9.